Safety net hospitals had smaller gains in quality-performance measures in a three-year period and were less likely to be high-performing over time compared with hospitals that had low percentages of Medicaid patients, according to a new study published in the Journal of the American Medical Association.
To examine the trends in quality-of-care disparities between hospitals with high and low percentages of Medicaid patients, researchers used publicly available data on hospital performance from 2004 to 2006. Of the 4,464 hospitals that participated, 3,665, or 82%, were included in the final analysis. Over time, hospitals with high percentages of Medicaid patientswhich the study said were more likely to be large, government and major teaching hospitalshad a lower probability of achieving high-performance status.
In a simulation model, these hospitals were more likely to incur financial penalties due to low performance and were less likely to receive bonuses, according to the study.
Researchers found that quality-improvement efforts could exacerbate existing disparities in three ways: hospitals that treat mostly poor and underserved patients may lack the resources to improve, or even to ensure accurate data collection for performance measurement; safety net hospitals may be penalized under incentive systems that reward the highest performers because they have lower performance at the baseline; and these hospitals do not have the same payer mix as other hospitals, and often are inconveniently located from the perspective of insured patients. -- by Jessica Zigmond
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